Splanchnic/Celiac/Hypogastric Plexus Blocks

The celiac plexus block and the splanchnic nerve block can be used for abdominal pain that may be caused by irritation, compression or entrapment of the nerve bundles within various abdominal organs, including due to tumor invasion, fibrosis, or chronic inflammation resulting from chronic pancreatitis or Crohn’s disease, among others. In particular, pain attributed to pancreatic cancer responds very well to a celiac plexus blockade.

The celiac plexus and the splanchnic nerves are the names of the sympathetic nerves involved in the function of the abdominal organs. They are a dense cluster of nerve cells and supporting tissue, located behind the stomach, in the region of the celiac artery just below the diaphragm. Nerve signals to the majority of abdominal organs flow through the celiac plexus and the splanchnic nerves. This includes the pancreas, liver, gallbladder, stomach, small intestine, and the parts of the colon.

Hypogastric Plexus

In a similar fashion, the hypogastric plexus is the name of the cluster of sympathetic nerves involved in the function of the pelvic organs such as the bladder, urethra, uterus, vagina, vulva, perineum, prostate, penis, testes, rectum, and descending colon. The superior hypogastric plexus sits just in front of the vertebral column at approximately the level of the fifth vertebral level and the first sacral level. This means that the plexus is located near the lower part of your abdomen where it joins with the upper part of the pelvis.

How It Works

The celiac plexus and the splanchnic nerve block are performed to diagnose and reduce abdominal pain caused by conditions such as cancer or pancreatitis. By blocking these nerve collections, pain signals can be reduced from organs in the abdomen. 

• A local anesthetic, steroid or ethyl-alcohol can be administered onto the plexus of the nerves using live x-ray guidance to visualize anatomic landmarks and accurately deposit medications.

• The use of alcohol, called a neurolytic block, because it destroys the nerves, can provide sustained pain relief in conditions where medications alone are not effective.

• A trial block is initially done with local anesthetic as a test to ensure there is pain relief. If substantial pain relief is acquired, a neurolytic block is performed.

In a similar fashion, the hypogastric plexus can be blocked for severe pain conditions arising from pelvic organs that are non-responsive to oral medications. The hypogastric block may be performed just once for diagnostic information to determine if the pelvic pain is coming from pelvic organs. In addition, these nerve blocks can sometimes be given as a series of several injections, repeated at weekly intervals, for potential therapeutic benefit.

• During the procedure, you will be asked to lie on your stomach.

• Your lower back will be cleaned with an antiseptic, and a sterile drape will be placed.  

• Your JLR Center for Pain Medicine physician will inject a numbing medication (local anesthetic) to numb the skin. 

• A needle will then be guided to the targeted vertebral body depending on which nerve plexus is being targeted. 

• Contrast dye will be injected to confirm the location of the needle along the intended landmark and to ensure the needle is in a safe position. 

• A small volume of numbing medicine will be injected onto the nerve plexus. 

• The needles will be removed, and a sterile dressing (band aid) will be applied. 

Risks

This procedure is safe. With any procedure, however, there are risks, side effects and possibility of complications. The most common side effect is temporary pain at the injection site. Other less common risks include bleeding, infection, spinal block, epidural block and injection into blood vessels and surrounding organs. There is also a very rare chance of injury to either the kidney or urethras. The urethras are the structure that connects your kidneys to your bladder. These risks are, again, extremely small and are even less likely when the procedure is performed under CT/x-ray guidance. Fortunately, serious side effects and complications are uncommon.